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Consolidated Update on the Health Impact

2008 Hurricane Season in the Caribbean

1. Main Public Health Issues

Health Services

18 September 2008 -Haiti: The only referral hospital in Gonaives (population 350 000), Department of Artibonite, was severely damaged and cannot function as a hospital in the future. The hospital morgue still has about 20 bodies that were stored there before the storm. Health departmental authorities envision the need for a field hospital for an extended period of time until a new hospital is built in a safe area. In addition, several areas in the southern peninsula and parts of the north remained inaccessible until recently, and health services were not able to be accessed by the public.

Cuba: Hurricane Gustav caused damage mainly in western Cuba on the Isla de la Juventud and the province of Pinar del Rio, whereas Hurricane Ike affected mainly the eastern part of the country, Maisi and Baracoa in Guantanamo.

Health infrastructure in western Cuba was severely damaged: 314 health facilities, 26 hospitals, 18 polyclinics, 191 family consultation offices, 14 homes for the elderly and 42 pharmacies, according to official sources. The tertiary care facility on Isla de la Juventud, the 396-bed capacity general hospital, ‘Héroes de Baire,’ delivers care to a population of 87 000, but the facility was severely damaged and is unable to function. Three primary health care clinics on the island have also been damaged as well as the main emergency unit, the epidemiological surveillance unit, and the municipal warehouse for medical supplies.

In the province of Pinar del Rio on the Cuban mainland, the 440-bed hospital ‘Comandante Pinares’ in the municipality of San Cristobal was seriously damaged. This hospital normally provides medical services to almost 200 000 people living in eastern Pinar del Rio. A health center was also totally destroyed, and a large number of family doctor facilities as well as pharmacies, municipal epidemiological and surveillance centres, laboratories and other primary health care facilities are non-functional.

Dominican Republic: About 43 835 persons were displaced and 8 767 homes affected. Two crucial road links in the southwest were flooded/damaged and the city of San Jose de Ocoa was cut off.

Jamaica: Eleven hospitals sustained structural damage; eight of them severely. Three hospitals had to relocate patients during the storm. All hospitals remained functioning throughout the storm. Seventy-two health centres were damaged; 21 severely damaged; two remain closed.

Turks and Caicos Islands: The Grand Turk Hospital sustained extensive roof damage, forcing the relocation of patients from its wards to the operating theatre during Hurricane Ike. Between 80-90% of homes were damaged and approximately 8% were destroyed in Grand Turk Island (pop. 4 800). More than 60% of buildings and 65% of homes were damaged in South Caicos Island (pop. 1 600). The loss of housing affected health providers, who were unable to come to work until they secured their families’ situation.

Water and Sanitation

Haiti: Access to potable water remains a high priority. All sanitation and latrines are virtually non-existent. No clean-up activities have begun, with the exception of the prison (carried out by PAHO/WHO for purely health humanitarian reasons) and the two main roads.

Jamaica: Water supply in the immediate aftermath of Hurricane Gustav was reduced to 65% (due to damage to the system). At present ,10-12% are still without pipe borne water. About eight communities (total population of 5 000) are still cut off and supplies are being delivered by helicopter. More than 1 000 latrines are estimated to have been destroyed or damaged.

Turks & Caicos Islands: The public water supply was interrupted, but it is common practice in Grand Turk for people to build rain water cisterns under or next to their houses. Although many of these cisterns suffered damage, the population was able to store at least a relatively large amount of fresh water. Piped-in water was interrupted in Grand Turk and South Caicos Islands due to the loss of power at the desalination plant.

A PAHO/WHO water and sanitation advisor was deployed to the islands to assist in monitoring of water sources, testing of water quality levels, treatment of contaminated water sources and purchase of chlorine and water testing equipment.

Surveillance & Control of Communicable Diseases

Haiti: The mosquito population is already increasing and has become a severe nuisance. Malaria and dengue cases, which are endemic in the area, are expected to increase. PAHO has developed a surveillance system using a reporting form which was disseminated to all agencies providing health services to affected areas. Reports are collated by the Ministry of Health and the PAHO office. PAHO has also submitted a proposal for surveillance in order to monitor and control expected outbreaks of communicable diseases in Haiti. A PAHO communicable disease specialist was positioned in Gonaives to assist in disaster coordination.

Jamaica: An increased number of cases of conjunctivitis was reported after the storm. No other disease outbreaks have been reported.

2. PAHO/WHO Response

Deployment of Public Health Experts

Haiti: The PAHO/WHO Regional Health Emergency Response Team was mobilized to support the PAHO/WHO Country Office and national authorities. Two disaster managers and two logistics officers are assisting both PAHO/WHO and all health partners. A water and sanitation engineer is on site and will liaise with the water and sanitation Cluster. He will also travel to Gonaives.

A PAHO/WHO epidemiologist was positioned in Gonaives to assist in disaster coordination, and PAHO/WHO also provided expertise on the management of dead bodies.

Cuba: One disaster manager was deployed to support the country office. PAHO/WHO is working with UN staff to prepare a second request for CERF funds for the areas most affected by Hurricane Ike. CERF funding post-Hurricane Gustav was approved. Funds are needed to buy chlorine, drugs and vaccines.

Jamaica: PAHO deployed two persons to assist in needs assessment and response in the management of humanitarian supplies (LSS/SUMA) and environmental health.

Turks & Caicos Islands PAHO/WHO water and sanitation advisor was deployed to assist in monitoring of water sources, testing of water quality levels, treatment of contaminated water sources and purchase of chlorine and water testing equipment. PAHO/WHO also organized the mobilization of 13 nurses from other Caribbean islands as well as a health management specialist to assist in managing the provision of health services.

Coordination

Health Cluster: PAHO/WHO is leading the Health Cluster in Haiti, organizing a thrice-weekly meeting in Port-au-Prince, co-chaired with the health disaster coordinator from the Ministry of Health, to exchange information regarding access to difficult areas, evaluation of needs and gaps, information on health status, health services delivery and response, water and sanitation.

In Gonaives, PAHO/WHO, MSF Belgium and the Ministry of Health are organizing daily Health Cluster meetings.

The information compiled by PAHO/WHO on damage to the health infrastructure is distributed to all partners through a distribution list, which includes international and national NGOs, UN agencies, Red Cross, CDC, and selected donors, such as OFDA and CIDA.

At PAHO/WHO Headquarters: PAHO/WHO Emergency Operations Center (EOC) provided updated information on the progress and impact of the various tropical storms and hurricanes to its internal and external partners, donors and other agencies, including the inter-American response network,by special briefings, daily situation reports and web postings and by multimedia for headquarters staff and visitors.

Surveillance

PAHO/WHO and the Ministry of Health, with assistance from CDC, Atlanta, prepared and distributed a surveillance form to all health partners working in the affected areas.

PAHO/WHO also provided technical support on the management of dead bodies, through a forensic expert who visited cemeteries and private mortuaries in Gonaives (which charge 500 Haitian dollars per day for the preservation of one body). One hundred seven bodies had already been buried in rudimentary graves, only 20cm deep. The same expert visited Cabaret’s private mortuaries where he assisted with the management of dead bodies.

Needs Assessment

PAHO/WHO staff in country and members of the Rgional Health Emergency Response Team took part in joint needs assessments after the storms. In Haiti, PAHO/WHO supported Health EOCs in Jacmel and Hinche, which remained open during Hurricane Gustav and provided continuous information from the field. The PAHO/WHO Representative in Haiti participated in an aerial surveillance mission to assess the flooding and other impact of the storms.

Needs assessments were also conducted by joint PAHO/National Disaster teams in Jamaica, Turks and Caicos and Cayman Islands.

Logistics

Haiti: The Saint Marc Hospital south of Gonaives and the MSF Hospitals in Port-au-Prince are acting as regional logistics hubs.

Stocks of basic drugs have been provided to Les Cayes, Gonaives, and Ennery (to the T. Louverture Hospital). One Interagency Emergency Health Kit was to the Ile de la Tortue through MSF Holland – Bomberos Unidos de Peru who will be working in the area. To date, some 19 medical kits for 10 000 persons have been distributed to four health centres and one surgical kit for St. Marc hospital

On the availability of transportation, drugs will be sent to Mont Saint Nicolas to cover the North West department including Bombardopolis, Jean Rabel and other small localities. Due to lack of access, fuel is not available in many affected areas. PAHO/WHO has purchased drums and provides them together with the drugs in order to ensure transportation from the harbour to the health centres. PAHO/WHO has also provided fuel to the hospital in Port de Paix with MINUSTAH assistance.

As fuel shortages hampered the functioning of the main hospitals in Cape Haitian (Justinien) and the hospital in Fort Liberte, PAHO/WHO has purchased 4 000 gallons of diesel through its office in the Dominican Republic. This fuel should sustain the two hospitals for thirty days.

Rapid test kits have been ordered for detection of malaria and dengue, and sutures and antibiotics have been requested.

Resource Mobilization

Contributions to (to date):

Haiti

CIDA Canada

Canadian $ 232,000

1 Inter-Agency Emergency Health Kit

USAID/OFDA

US$ 500,000

CERF

US$ 500,000

Cuba*

CERF

US$ 524,090

Turks and Caicos

DFID/UK

US$ 160,000

OAS Ambassadors’ Briefing

The PAHO EOC hosted a special briefing session after the passage of Hurricane Gustav for OAS Ambassadors and Representatives from Haiti, Jamaica, Dominican Republic, Grenada, the InterAmerican Development Bank, IICA, the World Bank and PADF. After the Hurricane Ike, the EOC prepared a briefing report for Jean-Ricot Dormeus, OAS advisor, for his visit to Haiti to see the damage caused by the flooding.

*Global Links is a medical relief and development organization dedicated that strives to health in developing countries by redirecting still useful materials away from the waste stream to public health improvement efforts in targeted countries in the western hemisphere. Global Links is seeking financial assistance to respond to the situation in Cuba.